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this population.The growing pervasiveness of opioid-based drugs such as fentanyl and its analogs represent a foremost hazard to the civilian population and burden on the first responders and clinicians. Thus, to enable a rapid and low-cost surveillance system to detect fentanyl in a non-ideal environment, we demonstrate the use of laser-induced nano-porous carbon structures directly onto commercially available polyimide sheets for rapid and cost-effective manufacturing of electrochemical sensors for fentanyl detection. The porous carbon surface instigated by various laser energy densities was analyzed towards morphological, vibrational, and fentanyl sensing properties. The results showed that laser carbonized electrode (LCE) prepared with 31 J/cm2 laser energy densities showed the highest level of porosity, surface roughness, and thereby enhanced sensitivity towards fentanyl detection by square-wave voltammetry (SWV) with a 1 µM limit of detection. This new disposable sensor strip offers an information-rich electrochemical fingerprint of fentanyl oxidation at + 0.526 V (vs Ag/AgCl) on the surface of laser carbonized electrodes with high linear (R2 = 0.99) sensitivity (0.025 µA⋅µM-1⋅cm-2) and reproducibility (RSD = 5%), within the clinically relevant working range of 20-200 µM with similar performance in both PBS and serum samples. The laser carbonized electrode surface was further found to be selective towards fentanyl concentrations in the presence of various cutting agents. This technology could provide a new route towards scalable manufacturing of cost-effective sensors for rapid detection of opioid misuse and potentially save the lives from systemic side effects.
The influence of lower limb ischemia on the loss of skeletal muscle mass, which is a prerequisite for sarcopenia, remains poorly studied in patients with peripheral artery disease (PAD). We determined whether or not lower limb ischemia correlates with a loss of skeletal muscle mass in patients with PAD.

The data of 101 patients (202 legs) with PAD were retrospectively analyzed. Body composition was measured using a bioelectrical impedance analysis. Based on the Asian Working Group for Sarcopenia, low muscle mass (LMM) was defined as skeletal muscle mass index (SMI) < 7.00 kg/m
(male) and < 5.70 kg/m
(female). Both univariable and multivariable analyses of the risk factors for LMM were performed.

There were significant differences in age, ankle-brachial pressure index (ABI) per patient, and the geriatric nutritional risk index (GNRI), between patients with and without LMM. Multivariable logistic regression analysis showed age (odds ratio [OR], 1.09; p = 0.009), GNRI (OR, 0.93; p = 0.003), and ABI per patient (OR, 0.02; p = 0.027) as independent risk factors for LMM.

These data show a detrimental effect of lower limb ischemia on skeletal muscle mass loss, suggesting that PAD may affect the development of secondary sarcopenia.
These data show a detrimental effect of lower limb ischemia on skeletal muscle mass loss, suggesting that PAD may affect the development of secondary sarcopenia.Two Gram-staining positive strains, FJAT-49825T and FJAT-50051T were isolated from a citrus rhizosphere soil sample. Strains FJAT-49825T and FJAT-50051T showed the highest 16S rRNA gene sequence similarity with the type strain of Neobacillus cucumis (98.4-98.5%). The 16S rRNA gene sequence similarity between strains FJAT-49825T and FJAT-50051T was 99.8%. Strain FJAT-49825T optimally grew at 35 °C, pH 6.0 in the absence of NaCl while strain FJAT-50051T grew at 40 °C, pH 7.0 and in presence of 2% NaCl (w/v). Both strains contained meso-2,6-diaminopimelic acid as the cell-wall diamino acid. The respiratory quinone of strains FJAT-49825T and FJAT-50051T was MK-7. The polar lipids of strain FJAT-49825T were diphosphatidylglycerol, phosphatidylglycerol, phosphatidylethanolamine, unidentified aminolipid and unidentified lipid whereas strain FJAT-50051T polar lipids were diphosphatidylglycerol, phosphatidylglycerol, phosphatidylethanolamine, unidentified phospholipid and unidentified lipid. The major fatty acids (> 10%) in both strains were iso-C150 and anteiso-C150. The genomic DNA G + C content of strains FJAT-49825T and FJAT-50051T were 40.8 and 41.1%, respectively. The average nucleotide identity and digital DNA-DNA hybridization value between strains FJAT-49825T and FJAT-50051T and with other members of the genus Neobacillus were lower than the cut-off value (95-96/70%) for interspecies identity. Based on the results, strains FJAT-49825T and FJAT-50051T represent two novel species of the genus Neobacillus, for which the names Neobacillus rhizophilus sp. nov. and Neobacillus citreus sp. nov. are proposed. The type strains are FJAT-49825T (= GDMCC 1.2592T = JCM 34834T) and FJAT-50051T (= GDMCC 1.2593T = JCM 34835T).
The roles of childhood abuse and interleukin (IL)-1β levels, a representative pro-inflammatory cytokine, in suicidal behavior are unclear. This study investigated the main and interactive effects of childhood abuse and IL-1β levels on suicidal behavior in patients with a depressive disorder before and after pharmacological treatment.

At baseline, exposure to self-reported childhood abuse, including emotional, physical, and sexual abuse, before the age of 16years, and IL-1β levels, were measured in 1,094 outpatients with a depressive disorder, 884 of whom were followed for 1year. Suicidal behavior was evaluated, including previous suicide attempts (at baseline), suicidal ideation (at baseline and follow-up), and fatal/non-fatal suicide attempts (at follow-up). The main and interaction effects of self-reported childhood abuse and IL-1β level on the four types of suicidal behavior were analyzed using logistic regression after adjusting for covariates.

Individual associations of self-reported childhood abuse were significant only with previous suicidal attempt but not with other suicidal behaviors. There was no significant association of plasma IL-1β level with any suicidal behavior. There were significant interactive associations of self-reported childhood abuse and a high IL-1β level on previous suicide attempts, baseline suicidal ideation, and fatal/non-fatal suicidal attempts during follow-up.

Suicidal behavior in patients with a depressive disorder could be influenced by considering the interactive effect of childhood abuse and IL-1β levels. Our study suggests that childhood trauma and biochemical factors play roles in the pathology of suicide in depressed patients.
Suicidal behavior in patients with a depressive disorder could be influenced by considering the interactive effect of childhood abuse and IL-1β levels. Our study suggests that childhood trauma and biochemical factors play roles in the pathology of suicide in depressed patients.
To determine the number of procedures and expert raters necessary to provide a reliable assessment of competence in Video-Assisted Thoracoscopic Surgery (VATS) lobectomy.

Three randomly selected VATS lobectomies were performed on a virtual reality simulator by participants with varying experience in VATS. Video recordings of the procedures were independently rated by three blinded VATS experts using a modified VATS lobectomy assessment tool (VATSAT). The unitary framework of validity was used to describe validity evidence, and generalizability theory was used to explore the reliability of different assessment options.

Forty-one participants (22 novices, 10 intermediates, and 9 experienced) performed a total of 123 lobectomies. Internal consistency reliability, inter-rater reliability, and test-retest reliability were 0.94, 0.85, and 0.90, respectively. Generalizability theory found that a minimum of two procedures and four raters or three procedures and three raters were needed to ensure the overall relpatients.
Submucosal tunneling endoscopic resection (STER) has been widely applied for esophageal submucosal tumors. This large volume study aims to provide a standard landscape of STER-related AEs for reference.

1701 patients with esophageal SMTs undergoing STER were included at Zhongshan Hospital, Fudan University. Data of clinical characteristics and adverse events were collected and analyzed in depth. Adverse events were recorded by ASGE lexicon and graded by ASGE grading/Clavien-Dindo system. Risk factors for major AEs were analyzed by univariate and multivariate logistic regression.

Three hundred and twenty (18.8%) patients with 962 cases of adverse events were observed. Accordingly, 84 (5.0%) were classified as major AEs (moderate and severe) by ASGE grading and 37 (2.2%) were classified as major AEs (grades III-V) by Clavien-Dindo grading. First 1 year operation, distance>6cm from incision to tumor, piecemeal resection, partially extraluminal location, mucosal injury, and operation time>60min were included in the risk score model for major AEs of STER, with 57.1% sensitivity and 87.5% specificity.

STER was a safe procedure for diagnosis and treatment of esophageal SMTs with a total 18.8% incidence of AEs, among which only 5.0% were major AEs requiring therapeutic measurements.
STER was a safe procedure for diagnosis and treatment of esophageal SMTs with a total 18.8% incidence of AEs, among which only 5.0% were major AEs requiring therapeutic measurements.
Despite advances in surgical technique, bile leak remains a common complication following hepatectomy. We sought to identify incidence of, risk factors for, and outcomes associated with biliary leak.

This is an ACS-NSQIP study. Distribution of bile leak stratified by surgical approach and hepatectomy type were identified. Univariate and multivariate factors associated with bile leak and outcomes were evaluated.

Robotic hepatectomy was associated with less bile leak (5.4% vs. 11.4%; p < 0.001) compared to open. There were no significant differences in bile leak between robotic and laparoscopic hepatectomy (5.4% vs. 5.3%; p = 0.905, respectively). Operative factors risk factors for bile leak in patients undergoing robotic hepatectomy included right hepatectomy [OR 4.42 (95% CI 1.74-11.20); p = 0.002], conversion [OR 4.40 (95% CI 1.39-11.72); p = 0.010], pringle maneuver [OR 3.19 (95% CI 1.03-9.88); p = 0.044], and drain placement [OR 28.25 (95% CI 8.34-95.72); p < 0.001]. click here Bile leak was associated with increased reoperation (8.7% vs 1.7%, p < 0.001), 30-day readmission (26.6% vs 6.8%, p < 0.001), 30-day mortality (2% vs 0.9%, p < 0.001), and complications (67.2% vs 23.4%, p < 0.001) for patients undergoing MIS hepatectomy.

While MIS confers less risk for bile leak than open hepatectomy, risk factors for bile leak in patients undergoing MIS hepatectomy were identified. Bile leaks were associated with multiple additional complications, and the robotic approach had an equal risk for bile leak than laparoscopic in this time period.
While MIS confers less risk for bile leak than open hepatectomy, risk factors for bile leak in patients undergoing MIS hepatectomy were identified. Bile leaks were associated with multiple additional complications, and the robotic approach had an equal risk for bile leak than laparoscopic in this time period.
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